Hyperemesis Gravidarum Presenting as Severe Hypokalemic Periodic Paralysis and Type II Respiratory Failure: A Different Form of Thyroid Storm?

Abstract

Hyperthyroidism in pregnancy is a condition that results from an excess of beta-human chorionic gonadotropin hormone resulting in gestational thyrotoxicosis. This thyrotoxicosis of pregnancy might be linked with hyperemesis gravidarum and is usually a self-limiting disease. Hyperthyroidism can cause hypokalemic periodic paralysis, which presents as pure motor areflexic flaccid paralysis. In severe cases, it may involve respiratory muscles and cause hypercapnic respiratory failure requiring invasive ventilation. A positive feed-forward cycle of hypokalemia could be triggered by the loss of function of inward rectifier potassium channel 18 (Kir2.6) along with the increased activity of sodium, potassium-adenosine triphosphatase (Na⁺/K⁺-ATPase). Hyperthyroid periodic paralysis is characterized by biochemical hyperthyroidism, normal urine potassium excretion, and electrocardiography abnormalities. We report a case of a 23-year-old female (G2P0L0A1) who had severe hyperemesis gravidarum and later on developed flaccid quadriplegia. Her thyroid profile revealed hyperthyroidism. She later developed hypercapnic respiratory failure and was managed by potassium replacement and invasive ventilation.

Electrocardiographic Manifestation in Thyrotoxic Periodic Paralysis

“…Thyrotoxicosis induced by high thyroid hormone intake is managed by stopping the related drug [19]. Moreover, in a rare case in which TPP was manifested in pregnancy with hyperemesis gravidarum, the resolution of the hyperemesis would also resolve hyperthyroidism [20]. Treatment with radioiodine ablation or thyroidectomy should be started promptly in cases of Graves' disease, toxic multinodular goiter, or toxic adenoma [1,9].…”

The effect of pressure algometer in pain threshold

“…This comprehensive study gives PPT value ranges for healthy controls, migraine, TTH, and CEH in the craniocervical area. This is significant considering the (17)(18)(19)(20)(21)(22)(23)(24)(25) PPT inspection point explanations ranged from exceedingly accurate and reproducible to a basic enumeration of locations in the body (For example, the entire tendon without specifying the particular place). The variety of measures, durations, and effectiveness of each assessment varied between investigations.…”

Role of artificial intelligence and Machine learning in musculoskeletal physiotherapy

“…With artificial intelligence the physiotherapist can endure learning with customized modules with which they can practice whenever they need to. (19)(20)(21)(22)(23)(24)(25)The speed of artificial intelligence adoption in different health care sectors will rapidly outpace the retirement of physiotherapist so in order to perform effectively. Physiotherapist must interact and work with artificial intelligence work program.…”